NCG060288_DMR_20210824

CERTIFICATE OF
FACILITY NAME
COUNTY Q
PERSON COLLEC
Part A: Stormw
Outfall No.
Benchmark
parameter Code
3
STORMVVATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO60000
ENO. NCGO6 0, i
i I ..
SAMPLES
J
SEP 01 2021
CCNI .RAL FILES
DWR SECTION
Date submitted Y Zl('Z/
SAMPLE COLLECTION YEAR
IOZ/
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
[_]Zero -flow ❑Watersupply ❑SA
Other fu. r F r ✓A�i
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Tntnl ovant rninfnll Z.q, 3 or n No discharge this period'
ater Benchmarks and
Monitoring ttesuas
COD,
- - - -
Oil and Grease,
- -
Fecal Coliform,
Enterococci,
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
mg/L
mg/L
Colonies per 100 ml
Colonies per loo ml
100or504
Within 6.0 - 9.0
120
30
3000'
S00'
C0530
00400
00340
00556
31616
61211
OS
-1, 17
r7
<ac
<s,c
nis/c712
O Y 07/
a D. v
[r
< 2 0
' Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
'For sampling periods with no discharge at anv outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
sMonthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes kno (if yes, complete Part B)
SWU-249, Last Revised 11/5/2018
Permit Date: 11/l/2018-05/31/2021 Page 1 of 2

r-r _--t -s v ".,tnr nil f mnnth
Part B: Vehicle Maintenance
Area Monitoring Results:
(mo/dd/yr)
only for tacauties averaging
mnt,:
triches2
46529
55 sal �■ ■■�--
New Motor Oilor
Hydraulic'OILUsage :,
•••-----• -- . --__ __
Non-Po-hounall lar:0&G/Total
.;Petroleum Hydrocarbons,
Total Suspended SolidsDateSampleColleced
Outfall No:
100 mg/L or 50 mg/O
Benchmarks
:.
NCOIL
00552; :..
C0530
Porameier.:Coder� . `�
`'
Footnotes from Part A also apply to Part Es
*FOR PART A AND PART B_MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER I HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES [:]NO[]
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who
g the information submitted is, to the best of my knowledge and
manage the system, or those persons directly responsible for gathering the information,
belief, true accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations."
Signatu;eof
Permit Date:11/1/2018-05/31/2021
7-',- 2
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2

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-.-1.. X__ 9_A1:41i,ftc wnrnnino 1 Sr. gal of now mntnr nil/month
Part B: venic{e maintenance
Outfall No..,
Hred MU111W111Is n=au106-7,
Date Sample Collected
(mo/dd/yr) '
v...r ■v■ ....•••�•`• ' r•__•-p--.p
24-hour rainfall amount,
Inchee
- -- v-- -- ---
New Motor Oil or
Hydraulic Oil Usage
-
Non -Polar O&G/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmark,.
-
-
-
15 mg/L
100 mg/L or 50 mg/O
PaMmeterZode
-
46529
NCOIL
00552:
CO530.
Footnotes from Part A also apply to Part B
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
_Mod an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring► period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617JI
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations."
Signature
Permit Date:11/1/2018-05/31/2021
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2